Thinking about Ideas in Nursing: 13th Philosophy in the Nurse’s World/23rd International Philosophy of Nursing Society Conference

Welcome to Jessica Dillard-Wright, who has now joined our
Nursology.net blogging team!
Jessica is a founding member of the
Nursing Theory Collective and
currently a PhD Student at Augusta University (Georgia)

I knew I was going to love Moby-Dick when I read the line, “Whenever I find myself growing grim about the mouth; whenever it is a damp, drizzly November in my soul; […] especially whenever my hypos get such an upper hand of me, that it requires a strong moral principle to prevent me from deliberately stepping into the street, and methodically knocking people’s hats off – then, I account it high time to get to sea as soon as I can” (Melville, 1851/1953, p. 17). And I did love it, still do. Sometimes the hypos get the upper hand of me, too, in particular when I am mired in the politics of nursing and education (not to mention the state of affairs we find ourselves in more broadly in the United States). This is especially the case when my ideas feel a couple of standard deviations outside the nursing norm. And then I find my way toward the niches and corners where other nurse dissidents reside and it’s like being at sea. 

The 13th Philosophy in the Nurse’s World/23rd International Philosophy of Nursing Society Conference was held August 18-20, 2019 in Victoria, B.C., a glorious coastal town IPONSlogothat satisfies the seaward impulse and welcomes a conference full of nursing philosophers. Dr. Thomas Foth’s opening plenary on the evening of the 18th softened my perioral grimness, asking us to contemplate the disciplinary apparatuses imposed through humanitarian efforts, focusing specifically on Canadian harm reduction and safe injection efforts for intravenous drug users. Here, Foth made the case that such humanitarian efforts paradoxically perpetuate individualist downstream interventions while failing to address structural inequalities. To this end, humanitarian efforts then shore up the neoliberal state, which in turn reproduces individual inequality and suffering. Foth concluded that the way forward for nursing was political action, oriented toward structural solutions to eliminate the foundations of human suffering. 

The question of politics was picked up in the second plenary session on the morning of the 19th, delivered by Dr. Sally Thorne. Thorne advanced a discussion of Carper’s ways of knowing in which she critiqued the dimension of personal ways of knowing. Thorne cited anti-science views held and advanced by some individual nurses, using anti-vaccination beliefs. Thorne urged nurses to develop a collective set of priorities and to use these priorities as a way to advance nursing writ large in an effort to avoid getting mired in individual nurses’ politics and beliefs. Following Thorne’s plenary, the concurrent sessions began.

In Dr. Kylie Smith’s collaboration with Foth on nursing history as philosophy, my soul found further refuge as Smith unpacked the complex legacy of nursing, the notion of care, and the work required for nurses to contribute to health equity and social justice. This marked another commonality in the concurrent sessions, which explored the hidden and suppressed stories of nursing, including the history of nursing, the colonialist and racist narratives housed within nursing’s assumptions, and the connection of nursing to greater social, cultural, and global challenges like climate injustice, enforced ignorance, and the impact of capitalism.

The critical thread that kicked off the conference was again picked up in a remarkable series of papers in the final concurrent session Dr. Marilou Gagnon first gave a concept analysis of the notion of “whistleblowing” in nursing, unpacking the complexity and muddiness of the concept. This was followed by Dr. Amelie Perron’s talk on the effects of ignorance and knowledge in nursing, advancing the idea of whistleblowing as an act of “epistemic disobedience,” challenging hegemonic order in nursing and healthcare systems. Together, Gagnon and Perron are directing the Nursing Observatory, a project focused on analyzing, acting, amplifying critical perspectives in Canadian nursing. The closing plenary was delivered by Dr. Janet Rankin, an empirical analysis of the “ruling forces” that shape nursing practice as nursing becomes increasingly technologically-dependent.

Of note, in contextualizing ideas in the nurses’ world, most of the papers (including those not commented on specifically here!) connected nursing to “outside” ideas like posthumanism, New Materialism, radical feminism, intersectionality, poststructuralism, neoliberalism, and social justice, situating nurses as political agents, encouraging nurses to engage critically with the ideas and influences that impact their practice, the communities they serve, their profession, and the world around them. A balm for the November drizzle, “the great flood-gates of the wonder world swung open” (p. 21) revealing possibility for nursing praxis, education, philosophy, and policy (Melville, 1851/1953). A call to political action for nursing. If you are interested in reading more, you can find the concurrent session abstracts here.

Currently, the International Philosophy of Nursing Society website is under construction but IPONS would love to have you. Please contact Mark Risjord at mrisjor@emory.edu to join. Look for more information soon on the IPONS conference for 2020, which will be held in Gothenburg, Sweden. 

References

Melville, H. (1953). Moby-dick or the white whale. London, UK: Collins Clear-Type Press.

(Original work published 1851).

 

This was written in conjunction with Jane Hopkins Walsh, who also attended IPONS 2019.

An Update from the Nursing Theory Collective

Welcome to Chloe Olivia Rose Littzen, who has now joined our
Nursology.net blogging team!
Chloe is a founding member of the
Nursing Theory Collective and
currently a PhD Student at the University of Arizona (Tuscon)

I. Introduction

In June of this year, a blog post was shared on Nursology.net by the Nursing Theory Collective, a group of scholars and students with a mission to advance the discipline of nursing/nursology through equitable and rigorous knowledge development using innovative nursing theory in all settings of practice, education, research, and policy. (Visit that post here). We are using the term nursing/nursology as at this moment in time as we continue to have discourse on the exact word choice we will use to characterize ourselves as a collective. 

To review, the Nursing Theory Collective was formed after the landmark conference, “Nursing Theory: A 50 Year Perspective Past and Future”, on March 21-22, 2019 at Case Western Reserve University. Since May, the group has met monthly to further discuss pivotal issues related to nursing theory and the identity of nursing/nursology, define their mission and vision statement, and to establish action items to drive their vision forward. Currently, the Nursing Theory Collective has 45 members from around the world including Canada, China, Colombia, and the United States, promoting a global perspective of nursing and nursing theory. 

To promote global connectivity, the Nursing Theory Collective created a WhatsApp (https://www.whatsapp.com) group for an easily accessible format that members in other countries can easily connect via their smartphones. In this WhatsApp group, members discuss pertinent issues related to nursing theory and the identity of nursing, sharing articles, actions in progress, or reminders for actions that evolved from previous meetings. Our meetings have been hosted via Zoom Video Conferencing (https://zoom.us) which enables access to participate in most countries, and has allowed us to record all meetings for future reference. A shared Google Drive was also created, enabling all members to have access previous document, to assist in the development of future action items, and to collaborate in real time. 

II. Updates 

To date, the meetings for our collective have revolved around discussions on actions items that can be taken to move the discipline of nursing and nursing theory into the future. In order to accomplish our collective goals, we have been working to define our mission, vision and values, and establishing logical action plans in the forms of scholarly writing and policy letters. In the following paragraphs, you will find a brief synopsis of all the action items that are in progress or completed. 

Mission, Vision, and Values. We have been working diligently on defining our mission, vision, and values as a collective. We recognize that this is a work in progress. We have been inspired by the vast body of prior nursing knowledge and theory work in the United States and abroad, as well as our individual philosophies of nursing. Guiding our mission, vision, and values is a concise definition of nursing theory first advanced by a working group of international nurse theorists, who proposed that nursing theory is simply “a description of what is going on” (Petrovskya, Purvis, & Bjornsdottir, 2019, p.2). Petrovskya, Purvis, and Bjornsdottir’s (2019), elegant definition, adopted from Rolland Munro, invites nurses to engage ideas beyond the theoretical paradigms most familiar to nurses educated in the United States. As this is an ongoing and open process, we invite you into the discussion and to add to our mission, vision, and values.

King Conference. In June 2019, the Nursing Theory Collective submitted an abstract that was accepted to the upcoming King Theory Conference in Washington, D.C. (King International Nursing Group, 2019). The topic of our abstract is, “Driving the Future of Nursing: A Collective Approach to Nursing Theory.” We look forward to being a part of this landmark conference. We plan to arrange a meeting of the Nursing Theory Collective at the King conference, and we welcome all members and non-members to join us for important discussions in driving nursing and nursing theory into the future. We will post details about the time and place for this get together as the date gets closer. One action item of this in-person meeting at the King Conference will be to continue the debate surrounding the adoption of the term nursology to characterize ourselves. 

III. Collaborative Efforts 

As we are a collective, we understand the importance of branching out and collaborating with individuals and groups to enable us to accomplish our mission and vision. To date, collaborative efforts have been placed into two categories: 1) Nursology, and 2) policy items related to nursing education and the future of nursing. Below is a brief synopsis of both of these efforts. 

Nursology. In 2015, Dr. Jacqueline Fawcett presented a case for changing the name of nursing to nursology (Fawcett et al., 2015). A variety of nursing scholars have echoed support for this change, but others have been questioning how this impacts on the discipline as we know it (Parse, 2019). To be mindful of all members views, we held an anonymous survey in June – July 2019 to adopt the term Nursology in our name, mission, vision and values. A total of eighteen votes were received, with 11 (61.1%) in support of adopting Nursology, and 7 (38.9%) in opposition. Members also had the option to write-in anonymously a rationale for their vote, and a variety of comments were received. For example, one member who was in support of the adoption asked “if there was an opposition for the collective to have an open discussion as to why this was.” Concerns that were raised by members in opposition included the marginalization of practicing and non-academic nurses, the validity and legitimacy of the term, and the belief that Nursology should be a term reserved for higher degrees in nursing such as the PhD. Supporters of the adoption argued that the term Nursology, while radical, would improve the strength of the identity of nursing, and has powerful implications for the general public and legislation.

Prior to the results being discussed, Dr. Fawcett kindly agreed to participate in our meeting where we discussed the adoption of the term Nursology, as well as the rationale for members in support or opposition. With this discussion, members had opportunities to further voice their opinion, and ask important questions related to the term and its meaning. For example, one member asked for whom the title nursologist should be reserved. Dr. Fawcett and other members designated the adoption of the term nursologist for all members, who have passed their licensing examination and are a registered nurse. At the end of the meeting, it was proposed as the group was undecided to adopt the term nursology into the mission, vision, and values, but also include nursing. We thank Dr. Fawcett for her involvement, and plan to keep the Nursology group updated as we move forward. Our next discussion on this topic will be in November at the King Conference in Washington, D.C.

Policy Items. In July, two members of the Nursing Theory Collective participated in a Zoom meeting with board members from the American Holistic Nurses Credentialing Corporation (AHNCC, 2019). The purpose of this meeting was to begin a discussion and collaborate on a campaign to express the need for nursing theory to be a core part of the current educational essentials, as they are being revised by the American Association of Colleges of Nursing (AACN) and the National Council of State Boards of Nursing (NCSBN). Action items from this meeting included the development of two letters focused on the educational essentials, as well as the revising of the National Council Licensure Examination for Registered Nurses (NCLEX-RN). To date, the letter to the AACN has been completed and is pending to be emailed out to key members of the essentials committee. After this, we plan to submit this letter for publication to spread the word of this important change that may impact the future of nursing. Our next step will be devising the letter the the NCSBN, we invite anyone who is interested in participating in developing this important letter. We thank the AHNCC for collaborating with us on this important project, and support them in their work as they promote a more holistic space for nurses to practice globally. 

IV. Future Efforts

While we have a significant to-do list as follow up from previous efforts, we continue to strive towards future actions in order to drive our vision for nursing and nursing theory into the future. We intend to remain vigilant about the AACN essentials, the NCSBN revision of the NCLEX, and will continue our activism aimed toward promotion of nursing theory at all levels of education. Our future actions include continuing our monthly meetings to have open discourse on the topic on nursing and nursing theory, we invite all members and non-members alike to participate. Additionally, we plan to write and submit manuscripts focused on demystifying nursing theory for practicing nurses and the educational environment. We welcome any and all ideas on how we can move forward with our goals, and hope that you would consider being a part of this movement. 

V. Conclusion and Invitation – Join us!

The next meeting for the Nursing Theory Collective is August 27th, at 2:00 PM Eastern Standard Time. We encourage all nurses and students, regardless of setting, experience, or educational level, to join us by contacting clittzen@email.arizona.edu to participate. If you are interested in joining the WhatsApp group, please email us to let us know and we will add you promptly. We also have a twitter handle, @NursingTheoryCo, and you are welcome to follow us as we plan future social media events. We plan to continue to update the community here on Nursology.net to keep everyone informed, as well as promote a movement of inclusivity to drive nursing and nursing theory into the future.

With gratitude,
The Nursing Theory Collective

References

American Holistic Nurses Credentialing Corporation. (2019). About AHNCC. Retrieved from https://www.ahncc.org/about-ahncc/

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., . . . Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28(4), 330-333. doi: 10.1177/0894318415599224

King International Nursing Group. (2019). Events. Retrieved from https://kingnursing.org/content.aspx?page_id=4002&club_id=459369&item_id=976945

The Nursing Theory Collective. (2019, June 18). Moving Towards the Next Fifty Years Together [Blog post]. Retreived from https://nursology.net/2019/06/18/moving-towards-the-next-fifty-years-together/

Parse, R. R. (2019). Nursology: What’s in a name? Nursing Science Quarterly, 32(2). doi: 10.1177/0894318419831619

Petrovskaya, O., Purkis, M. E., & Bjornsdottir, K. (2019). Revisiting “Intelligent Nursing”: Olga Petrovskaya in conversation with Mary Ellen Purkis and Kristin Bjornsdottir. Nursing Philosophy, 20(3), e12259. doi: 10.1111/nup.12259.

Tribute to our Nurse Friends!

We welcome this guest post by Shannon Constantinides, MSN, NP-C, FNP, UCHealth Primary Care,  PhD Student, Florida Atlantic University.  Shannon also contributed the content on Jane Georges’ Theory of Emancipatory Compassion

Shannon Constantinides

In trying to explain to my husband (an osteopathic physician) why Nurses’ Week is an important week, I asked him, “Do you ever notice that I have my “friends” … but that I also have my “nurse friends?” He looked back at me, a bit quizzically, shrugged his shoulders and said, “yeah…? I guess so?” In a conversation a day or so later, he said, “Now that you’ve mentioned it, I guess I have heard you mention your Nurse Friends.” He then gave me a somewhat perplexed look and said, “I have friends who are physicians, but I don’t think I have Physician Friends. At least not in the way you talk about your Nurse Friends.” You’re right, my dear, you don’t.

From the inception of the profession, nurses have been working together, side by side in the figurative and literal “trenches.” Whereas our physician colleagues are trained to be the lone wolves, or as I’ve heard it described, “the captain of the ship,” nurses are from the onset of training, trained to work as part of a team.

This Nurses’ Week, I set an intention to celebrate and honor all my Nurse Friends. To me, Nurses’ Week is a reminder about the joy we find in work – not just the experiences that arise from patient care – but also joy we find from the relationships we’ve built with one another along the way.

In 2018, I had the honor and privilege to interview Dr. Jane Georges, Dean of the Hahn School of Nursing at the University of San Diego and the author of the Emancipatory Theory of Compassion. During the course of our conversation, we got onto the topic of finding joy in work and Nurse Friends. Until Dr. Georges pointed it out, I hadn’t given much thought to the concept of Nurse Friends. My mom, a 30-year NICU RN, had Nurse Friends. Dr. Georges’ mother was also a nurse who had Nurse Friends. “NurseFriends” was simply a word we’d always known, because we both grown up with the knowledge that there are two kinds of friends: your friends, and your NurseFriends.

In discussing ways in which we can recapture joy in work and joy in nursing, Dr. Georges circled back to the concept of NurseFriends and the deep connection nurses share with one another; the connection that allows us to find so much meaning in what we do. “I call it the nurse-nurse bond,” Dr. Georges said, “It’s knowing that we can’t do it alone, which is one of the most beautiful parts of nursing.” In recalling some of the most healing environments in which she’d worked, Dr. Georges commented on the presence of joy, respect, and connection with other nurses.

“We just had this crew,” I mentioned as I reminisced about a group night-shift NurseFriends I worked with during my tenure working in an emergency department. Dr. Georges agreed, “I think the idea of the nurse-nurse bond, or NurseFriends, is worth exploring… how do we build back that community where we’re not adversarial to each other?” I think that the answer lies within ourselves and within the community of our discipline: building up our NurseFriends to strengthen one another, to strengthen the profession, to strengthen ourselves, and ultimately, to strengthen the care we give our patients.

Two years ago, I had to tell a NurseFriend who’d become my primary care patient that I’d found lymphoma on her MRI. That was one of the worst days of my professional career. I remember sitting in my office, sick to my stomach. Delivering bad news to a patient is never easy; delivering bad news to a NurseFriend will break your heart.

This NurseFriend is doing great. Her cancer is in remission. She’s healthy. She’s now the clinical manager of my primary care office. I’m lucky: we caught her cancer early, got her great treatment, and I get to see her smiling face every day.

To all of my NurseFriends, thank you for sharing your light with me. You are my heros not just during Nurses’ Week, but every week!

Inspired by Virginia Henderson

Henderson when she was a research associate at Yale (from https://nurseslabs.com/virginia-henderson/)

I first met Virginia Henderson when I was a student at Yale School of Nursing. She was a guest in one of our courses, and she started the class by saying, “I’m a million years old and deaf as a doornail, so speak up!” She was a force, and I loved her from the start. I had the opportunity to meet with Virginia at her home in New Haven, CT, where she showed a group of us her porcelain box collection. She even gave me one! Virginia was at our graduation from YSN in 1993 – in full academic regalia. The last time I saw Virginia was at her home in a retirement community in Connecticut. I consider myself fortunate to have spent time with such an influential nurse. Although I had no idea at the time, her work and thoughts on nursing shaped my own. Her definition of nursing

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.

resonates with me because in my work with people who have diabetes I see the need to help people toward independence. Diabetes and other chronic diseases require knowledge, skills, and understanding so that people can make daily decisions and perform daily tasks to manage their disease and live well. There are times when people need more – education, direct care, or support – and times when they can function independently. The goal is always to help people toward independence and away from a mentality of “compliance” or “adherence.” I think Virginia would support the language movement in diabetes, where we are working hard to get away from judgmental, provider-centric language and move toward person-centered and strengths-based messages.

I also identify with Virginia’s beliefs on nursing as a discipline with a distinct body of knowledge and her emphasis on nursing education and nursing research. Ironically, I was a student at Yale School of Nursing and now teach at Teachers College Columbia University. Both schools had an impact on and were influenced by Virginia Henderson. It’s amazing to me that I have felt her presence throughout my career, despite not being directly connected to her work.

I sometimes wonder what Virginia would think if she were alive today. Is her definition of nursing being upheld? What would she think of nursing practice, nursing education, and nursing research? Are we honoring her legacy in our work today? It’s important for nurses to be aware of those who’ve gone before us, their work, and their influence on our discipline. Some of those nurses are still with us, and my hope is that we will learn from them and be shaped by them as we move nursing forward. When we practice, teach, and study, how often do we think about our own definition of nursing? Are we being true to that definition?